Name:___                                           

Phone:___

 Fax:___

 

Ph: __ Temp: __   Tank Size:___

Tank Mate:___

Are you going to quarantine the new fish in a quarantine tank ?___

 How are you going to acclimate the new fish?  Floating?___ Dripping?___

 What would you like to order?        ___

___

___

___

 ___

 

Arrival Date: ___  Ship to : (name of airport) :__   OR ship to my door :___

 

Ship To Address:____Apt#? Suite#?___

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How would you like to pay? Money Order/ Visa/Master Cards/ Paypal?

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 Other Info:____